oxygen therapy fundamentals of nursing instructor: r. hanock reading assignment: fundamentals...
TRANSCRIPT
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Oxygen TherapyFundamentals of
nursingInstructor: R. Hanock
Reading assignment: Fundamentals textbook (Burton)pages: 614-627, 636-638 (skills 28-3, 28-4 & 28-5)
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Objectives: O2 Therapy
• At the completion of this unit: The student will be able to: 1)Describe nursing interventions & routines that facilitate
safe oxygen administration2)Describe the various equipment items & methods of O2
delivery utilized to facilitate improved oxygenation. 3)State the S&S and underlying factors related to COPD,
hypoxemia, & oxygen toxicity.4)Explain assessment and documentation principles relating
to the care of patients receiving O2 therapy.
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Anatomy Overview
Upper airway: nose, mouth, pharynx, & upper trachea
LungsLeft lung - two lobesRight lung - three lobes
> bronchi divide into bronchioles> bronchioles terminate at the alveoli
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Oxygen TherapyOxygen is a medication and requires a physician
order. Apply the 5 rights to medication administration
Facilities often have protocols in place of MD orders. (I.e.: weaning protocols)
Nursing responsibility: Always ensure that O2 is set to the prescribed rate.
The universal color for O2 receptacles & equipment is _______________________
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Oxygen Administration
•Supplement oxygen in inspired air•Delivered by nasal cannula, mask, tent, croupette, or catheter•Requires humidification, flow rate prescribed by
physician
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Ambu-Bag used for resuscitationProvides ventilation in emergency
situations
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Oxygen Administration
•Flow rates: 1-6 L/minute
1 L/min = 24%, 3L/min = 32%, 6L/min=44%
•PTs with COPD given only 1-2 L/minute to prevent respiratory depression
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Position Lung Expansion Increasedsurface area for gas exchange
Improved gas exchange (ventilation)
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Artificial Airways
•Nasopharyngeal (P.626, FIG 28-5)•Oropharyngeal •Endotracheal tubes (p.626 FIG 28-5)•Tracheostomy (P.627 FIG •28-8)
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Pulse oximetry
* Measuring oxygen saturation of hemoglobin
•Monitors PTs at risk for hypoxemia•Physicians order or nurses discretion•http://www.youtube.com/watch?v=Cj_M-vWGbWQ
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Pulse Oximetry Devices:measure the O2 saturationlevels of arterial blood by use of light waves. (skill 17-8, p. 371)
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Airway ObstructionAirway Obstruction
•Common causes of airway obstructions
1)Choking: airway occlusion
2)Disease processes (commonly neurological deficits)
3)Respiratory secretions
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Aspiration precautions
• Keep upright during and after meals• Avoid thin liquids• Crush medications
or use liquid forms• Keep suction set up
at bed side
• Place food in unaffected side of mouth (CVA clients) • Tuck chin to chest
when swallowing
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Nubulizer Treatments
•Hand held nebulizer•Nebulizer is a medication delivery system: air compressor, medication cup, mask or hand-held mouth piece•Vapor (mist) is inhaled into airways direct affects less systemic affects•Review p.636, skill 28-4
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Metered-Dose Inhaler/Multi-Dose Inhaler (MDI)
May be used with or without a spacer, requires assessment Measured doses of medicationDeliver dose during deep inhalationMedications dispersed in mistCompliance problems: complex task for some
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Incentive spirometer
Teaching your patient about incentive spirometry
p.620: Patient Teaching Connection
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Incentive Spirometer: Components
Piston Type Sphere Type
Nursing Instruction: Lift the spheres or piston as high as you can and hold them up for as long as you can with the deepest and longest inhalation that you are capable of. Perform 10 deep breathes every hour while you are awake and are not fatigued.
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Equipment: Delivery Systems
Ps 623-625, table 28-4Nasal cannulaMasks• Simple face mask• Partial rebreather• Nonrebreather• Venturi mask• Face tent
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Nasal Cannula: Low O2 Flow Delivery
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Simple Face Mask: Delivers 40 to 60% O2 concentrations
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Partial-Rebreather and Non-Rebreather MasksDifference is with the ports & valves
Reservoir bagPartial rebreather: CO2 is Exhaled into reservoir bag and Side ports (valves/vents) close during Exhalation CO2 is then Inhaled.
Non-rebreather: the Reservoir valves close and sideVents open during exhalation. CO2 is not available during Inhalation.
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Venti-Mask: Delivers 24-80% O2Dial to change O2 concentration delivery
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Tracheostomy with direct attachmentCollars are frequently used
Tracheostomy shortensThe airway less workTo breathe and Expectorate secretions
Direct attachment usedWhen on ventilator.
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T-Piece Attached to Tracheostomy
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Oxygen & Humidity Tents
- For infants & young children• Cool saturated air to keep respiratory tract well hydrated•Used for croup, pneumonia, or other upper respiratory diseases
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Face TentDoes not deliver precise O2 concentrations
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Patient Care Concerns•Psychological
•Safety •Fire Hazards•Pressure Hazards•Malfunctioning Equipment
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Equipment
•Flow meter•Regulator•Pressure gauge•Humidifier•Sterile water
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Pin index safety system
Most small O2 transport cylinders utilize the pin system to ensure proper placement of the O2 regulator.
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Oxygen Regulators
•Bourdon Gauge Brass Steel Aluminum
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Oxygen Regulators
•Grab n GO Brass
Tank Construction Steel Aluminum
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Humidification of Oxygen
•Moderate & high levels of O2 are drying and irritating to the mucous membranes of the airways. •A humidification device must be
attached to the flow meter to humidify O2.
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Oxygen Cylinder Storage
Storage:• Stationary Holders
Transport:• Rolling Stands• Bed stands
All cylinders must be stored securely!All cylinders must be stored securely!
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Magnetic Fields
• Steel Cylinders and regulators may become projectiles when near a strong magnetic field.
Exercise extreme caution when near a Magnetic field
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DOs and DON'Ts with Oxygen Equipment
• Don't allow smoking around oxygen. • Do maintain oxygen equipment as
the supplier & JCAHO instruct. Work closely with the respiratory therapy department. • Don't use equipment which is visibly
dirty, in poor repair, or damaged. • Do use plugs, caps and plastic bags
to protect "off duty" equipment from dust and dirt.
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Oxygen Therapy Safety Precautions•Oxygen tanks contain oxygen under pressure•Oxygen supports combustion
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Potential Physiological Problems
> Loss of stimulus to breath for those with Chronic Obstructive Pulmonary Disease (COPD)
1 – 2 L/Minute only > Oxygen is drying to
respiratory membranes> Lung tissue damage occurs
from continued use of high concentrations of O2.
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Hypoxemia
• Impaired gas exchange•Resp. Insufficiency: ↓ oxygen level in blood caused by resp system abnormalities•Results in inability to meet cellular oxygen needs (hypoxia) &/or inability to remove excess carbon dioxide (hypercapnia).
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Hypoxemia
•Onset can be rapid or gradual while early signs are without difficulty breathing i.e.: dyspnea, labored respirations, SOB
•Health threat: prolonged hypoxemia & hypercapnia starves tissues of O2 & causes acidosis tissue necrosis tissue death
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Early S&S of HYPOXEMIA
1. Confusion, restlessness, irritability, anxiety
2.Confusion – change in mental status - (The first sign, occurs before other symptoms)
3.Tachypnea (rapid breathing) will become labored if prolonged (compensatory mechanism)
4. SOB: moving to later stage, becoming too fatigued to continue compensating.
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Later S&S HYPOXEMIA
5. Cyanosis6. Retractions – inward muscle movement of intercostal spaces; neck & abdomen muscle involvement7. Acid-base balance disturbance8. ↓ oxygen saturation
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Oxygen Toxicity
•O2 Toxicity may develop when O2 concentrations of > 50% are administered for > than 48 to 72 hrs. •Prolonged use of high O2 concentrations
reduces surfactant production & causes lung tissue damage
a) alveolar collapse b) reduced lung elasticity • Early sign of O2 toxicity = dry cough
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Procedures for O2 admin
•Assessment, Check physician orders, & consult with respiratory therapy• - Resp assessment: rate, depth, sat, lung sounds, subjective data•Auscultate - compare areas, side to side
•Planning• Implementation•Evaluation
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Documentation
•Data from respiratory assessment•Oxygen flow rate & method of delivery• Amount prn oxygen used• Time & location of blood gas sampling• Location of oximetry probe & range of saturation•Description of sputum expectorated• Coughing and deep breathing exercises• Time & evaluation of respiratory treatments
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Documentation• Date/TimeNursing DX: Impaired gas exchange: Dyspnea on
exertion• S: “Walking makes me short of breath”.• O: Respirations 34 & shallow after 30 min rest
period. (continue with data collection)• A: Dyspnea unrelieved by rest.• P: Administer O2 3L/min via nasal cannula per
protocol. Dr. Wilson notified. Reassess in 30 min.
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Documentation: Narrative
•Date/Time•Complained of mild dyspnea on ambulation. Respirations 34 & shallow after 30 min rest. O2 at 3L/min. started via nasal cannula per standing order. (include all data from resp assessment) Dr. Wilson notified.
Nancy Nurse LPN
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Closure: O2 Administration
Critical Thinking: why did I make the background of this presentation green?
1)Review questions: chap. 28, p. 645-6 questions 1-6. 2) Video activity3) Lab activity review4) Review activities work-sheet